Learning objectives
The aim of the course is to provide the scientific underpinnings to acquire a deep understanding of the role of nutrition in human physiology an diseases.
Knowledge and understanding
• Acquire basic knowledge of human relevant physiology for nutrition.
• Acquire knowledge of the intimate links between thermodynamics and nutritional physiology and pathophysiology
• Acquire ability to use the specific language of the discipline
Knowledge and understanding applied
• Apply theoretical knowledge to the practice of human nutrition
Judgment autonomy
• Understand the relevance of the different levels of scientific evidence for prescription in human nutrition and nutraceutics
Communication skills
• Have the ability to synthesize information and communicate it effectively to professional and non-professional questioners.
Learning skills
• Develop skills and methodology that allow you to study in a highly autonomous way
• Ability to update through the consultation of scientific databases
Prerequisites
Course unit content
Basic knowledge of key organs and cells will be reviewed, focusing on the roles played in metabolism and nutrition. Physiologic and psychological bases of eating behavior disorders will be illustrated. Special attention will be devoted to definition, classification and epidemiology of most relevant pathologies, with emphasis given to the nutritional impact of chronic diseases. Methods to assess nutritional status in several conditions will be presented, focusing also on possible limitations and ambiguities due to multiple pathophysiological and technical factors.
The etiology and mechanism(s) of hypo- and/or mal-nutrition in several pathological conditions will be highlighted. The roles played by molecular pathways (e.g. hormones, inflammation, etc.) and by microbiome/microbiota and their relevance to metabolism and nutrition will be elucidated. The intertwining of social, psychological and pathophysiologic factors in eating behavior disorders will be illustrated. The impact of different dietary habits and diets on physiology and pathophysiology of organs, conditions an diseases will be reviewed. Evidence-based dietary and nutritional interventions aiming at preventing and/or treating most common clinical conditions will be examined, also in comparison to other treatment options. The student will be offered competences and skills needed to assess the nutritional status and to select most appropriate dietary counseling and prescription for the most common and/or relevant risk conditions and diseases.
Full programme
Mod. 1. Practical Approach to Nutrition in Endocrinology and Metabolism
0.Thermodynamics of the biological systems.1. Human physiology of Endocrinology and Metabolism
2. Scientific evidence in Medicine: methods and tools – assessment and construction
3. Nutritional habits and their impact on health: from the population to the single individual level and back
4. Nutritional status: assessment and significance – toolbox and practical aspects
5. Food and nutrition policies and interventions
6. Body composition: assessment and significance – toolbox and practical aspects
7. Energy turnover: from thermodynamics to human biology – toolbox and practical knowledge
8. Healthy and unhealthy diets: from scientific evidence to prescription
9. Dietary requirements in specific groups.
a. The pregnant woman
b. The breastfeeding woman
c. The athlete
10. Nutrition and:
a. Skeleton
b. Cancer
11. Dietary prevention of obesity: evidence-based practical approaches
12. Dietary prevention of cardiometabolic risk: evidence-based practical approaches
13. Dietary prevention of type 2 diabetes: evidence-based practical approaches
Mod. 2. Practical Approach to Nutrition in Internal Medicine
1.Specifities of older persons (acute and/or chronic disease; related degenerative changes; limitations in physical, cognitive and/or social functions; reduced ability to perform ADL; increased need of rehabilitative, physical, psychological and social care requiring a holistic approach).
2.Chronological versus biological Age (main aim of geriatric medicine to optimize functional status and quality of life).
3.Multimorbidity and polypharmacy
4.Nutritional assessment (history of diseases and weight, body composition, biochemical evaluation in older heathy and multimorbid subjects)
5.Dysphagia and Sarcopenia as main geriatric syndromes: evidence-based approaches from guidelines
6.Nutritional challenges in older persons (malnutrition, dehydration, obesity).
7.Anorexia of Aging: the role of Inflammaging, Hormonal status, and Mitochondrial dysfunction
8.Nutrition and Cognitive impairment
9.Changing nutrients needs in older adults (Espen Guidelines, EFSA, Italian (...) assunzione raccomandata, adeguata, ecc..). Macro and micro-nutrients: protein needs/intake (anabolic resistance, nitrogen balance, protein/aminoacids type, amount, protein pattern); lipids; energy intake; hydration; micronutrients (Mg, iron, Vitamins ecc..)
10.Supplementation of nutritional deficiencies: how and when
Mod. 3. Practical Approach to Nutrition in Cardiology
Diet and cardiovascular health
Dietary prevention of target organ/tissue damage secondary to high blood pressure: evidence based practical approaches
Dietary prevention of target organ/tissue damage due to atherosclerosis: evidence based practical approaches
Dietary prevention of and during cardiac arrhythmias: evidence based practical approaches
Dietary prevention of and during chronic heart failure: evidence based practical approaches
Mod. 4. Practical Approaches to Nutrition in Gastroenterology
1. Digestion and absorption: bases of physiology of the digestive system
2. Malabsorption
a) Definition and main mechanisms
b) Celiac disease: i) bases of physiopathology
ii) clinical presentation
iii) nutrition in celiac disease
3. Inflammatory bowel disease:
a) Bases of physiopathology
b) Clinical presentation
c) Nutritional consequences of IBD
d) Nutrition in IBD: i) what, how and when to supplement
ii) nutrition as therapy (polymeric diet etc.)
4. Reflux disease and peptic disease:
a) Bases of physiopathology
b) Nutrition in reflux- and peptic disease
5. Artificial nutrition:
a) Definitions: enteral and parenteral nutrition
b) Main indications of naso-gastric tube, PEG, PEJ, nutritional jejunostomy, parenteral nutrition
c) Bases of administration of artificial nutrition (how to modulate products and caloric intake)
Mod. 5. Practical Approaches to Nutrition in Kidney Disorders
1.The kidney: notes on the function and tasks of the kidney, the kidney and nutrient metabolism
2. Chronic kidney disease (CKD): definition, stages, pathophysiology
3. Evaluation of nutritional status in renal patients
a. Evaluation of dietary intake
b. Anthropometric measurements
c. Biochemical parameters
d. Assessment of body composition and assessment of lean body mass in patients with kidney disease
e. Nitrogen balance and energy balance in the CKD
4.Pathogenesis of malnutrition in CKD patients
5. Intestinal microbiota alterations and nutritional status in CKD
6. Diet and acid-base metabolism in CKD
7. Phosphorus metabolism in CKD, sources of phosphorus in food and additives, controlled phosphorus diets, use of phosphorus chelating agents
7a. Potassium metabolism in chronic kidney disease, vegetarian and non-vegetarian diets, intestinal potassium chelating agents in the diet of patients with CKD
8. Controlled protein diets (low protein diets) in CKD and conservative treatment (non dialysis) of CKD
9. Notes on nutrition in patients on hemodialysis and peritoneal dialysis
Mod. 6. Practical Approaches to Nutrition in Eating Behavior Disorders (EBD)
1. ED Psychopathology
2. The integrated treatment for Eating Disorders: national and international guidelines
3. The method of Progressive Psycho-nutritional Rehabilitation (RPP®) for ED: RPP® goals; RPP® instruments (dietary diary; personalized dietary plan).
Bibliography
Rivellese A, Annuzzi G, Capaldo B, Vaccaro O, Riccardi G - "Nutrizione Umana" - Ed. Idelson Gnocchi, 2017
"Human Nutrition" 13th Edition, Eds Geissler C & Powers H, Oxford University Press, 2017
Further reference handbooks, sources can be listed within the specific modules.
Teaching methods
The course will be held through lectures to Students either in the classroom (“in presenza”) or in synchronous-streaming (“in telepresenza”) on the Teams platform. Therefore, the opportunity of Student/Teacher interaction will be preserved both face to face and remotely, by the simultaneous use of the Teams platform.
Lectures will be supported by slide presentations, some of which will be available to students on the Elly platform (https://elly.medicina.unipr.it).
Assessment methods and criteria
Oral examination (in English, on specific justified request) or multiple choice question test.
Range of assessment values: 1-30 (30 best)
In case of the persistence of the health emergency, the exams will be conducted remotely, as follows:
remote oral questions, through the Teams platform (guide http://selma.unipr.it/).
Students with SLD / BSE must first contact Le Eli-che: support for students with disabilities, D.S.A., B.E.S. (https://sea.unipr.it/it/servizi/le-eli-che-supporto-studenti-con-disabilita-dsa-bes)
Alternatively, multiple choice questionnaire may be used via Elly and Teams.
Range of assessment values: 1-30 (30 best)
Other information
2030 agenda goals for sustainable development
Tools an intervention inspired by the principle of equity and aiming at evidence-based nutrition.
